U.S. patent number 7,108,698 [Application Number 10/756,040] was granted by the patent office on 2006-09-19 for combined distractor and retractor instrument and methods.
This patent grant is currently assigned to Zimmer Spine, Inc.. Invention is credited to Erik E. Emstad, Daniel S. Robbins.
United States Patent |
7,108,698 |
Robbins , et al. |
September 19, 2006 |
**Please see images for:
( Certificate of Correction ) ** |
Combined distractor and retractor instrument and methods
Abstract
A surgical instrument for use during a spinal surgery procedure.
The surgical instrument being configured to distract two adjacent
vertebral elements and retract the nerve root to provide access to
the distracted site. The instrument including an elongated blade
member having a wing located on an edge of the blade member, and a
handle.
Inventors: |
Robbins; Daniel S. (North
Bennington, VT), Emstad; Erik E. (St. Paul, MN) |
Assignee: |
Zimmer Spine, Inc.
(Minneapolis, MN)
|
Family
ID: |
34739737 |
Appl.
No.: |
10/756,040 |
Filed: |
January 13, 2004 |
Prior Publication Data
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Document
Identifier |
Publication Date |
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US 20050154395 A1 |
Jul 14, 2005 |
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Current U.S.
Class: |
606/90; 600/210;
606/105; 606/86R |
Current CPC
Class: |
A61B
17/025 (20130101); A61B 2017/0256 (20130101) |
Current International
Class: |
A61B
17/60 (20060101) |
Field of
Search: |
;600/210,226,217,86,220,235,237,239,240,242,243,201,211
;606/86,90,105,53 ;623/17.11-17.16 |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
Primary Examiner: Bianco; Patricia
Assistant Examiner: Kilkenny; Patrick J.
Attorney, Agent or Firm: Wood, Herron & Evans, LLP
Claims
What is claimed is:
1. A surgical instrument, comprising: a) an elongated member having
a first end and a second end, and a first edge and a second edge,
the first end defining a curved region, wherein the curved region
of the elongated member has a convex curvature relative to the
plane defined by the first and second edges of the elongated
member, the second edge further including a recess formed in the
elongated member; b) a handle extending from the elongated member,
the handle being positioned adjacent to the second end of the
elongated member; and c) a wing extending outward from the first
edge of the elongated member, the wing being positioned between the
curved region and the handle; wherein the wing is used to retract a
nerve root.
2. The instrument of claim 1, wherein the recess is formed adjacent
to the first end of the elongated member.
3. The instrument of claim 2, wherein the curved region extends to
a rounded tip.
4. The instrument of claim 3, wherein the first and second edges
extend generally parallel to a longitudinal axis of the elongated
member.
5. The instrument of claim 1, wherein the elongated member has a
concave curvature relative to a plane defined by the first and
second edges, the concave curvature extending along a majority of
the elongated member.
6. A surgical instrument, comprising: a) an elongated member
including a longitudinal axis extending from a first end to a
second end, and first and second edges extending generally parallel
to the longitudinal axis; b) a handle positioned adjacent to the
second end of the elongated member; c) a wing extending outward
from one of the first and second edges of the elongated member; and
the wing being positioned between the first end and the handle d) a
recess formed in the other of the first and second edges of the
elongated member.
7. The instrument of claim 6, wherein the wing and recess are
located adjacent to the first end of the elongated member.
8. The instrument of claim 6, wherein the elongated member includes
a curved region located between the first end of the elongated
member and the wing.
9. A method of distracting first and second adjacent vertebral
elements, the method comprising: a) providing a surgical instrument
having; (i) an elongated member having a first end and a second
end, and a first edge and a second edge, the first end defining a
curved region, wherein the curved region of the elongated member
has a convex curvature relative to the plane defined by the first
and second edges of the elongated member; (ii) a handle extending
from the elongated member, the handle being positioned adjacent to
the second end of the elongated member; and (iii) a wing extending
outward from the elongated member, the wing being positioned
between the curved region and the handle; b) inserting the the
curved region in a first orientation between the first and second
vertebral elements; c) positioning the wing adjacent a nerve root;
and d) rotating the instrument to simultaneously retract a nerve
root and distract the first and second vertebral elements a
distance.
10. The method of claim 9, wherein the distance of distraction is
determined by a width of the elongated blade member.
11. The method of claim 9, wherein the instrument is rotated
approximately 90 degrees.
Description
TECHNICAL FIELD
This disclosure relates generally to methods and devices for
accessing an area of a patient's spinal column during a surgical
procedure. More particularly, this disclosure relates to an
instrument that provides an accessible space between two vertebral
elements.
BACKGROUND
A wide variety of surgical techniques have been used to access the
spinal column in spinal surgery procedures. For example, some
techniques include making an incision in the patient's back and
retracting or separating tissue and muscle to expose a wide area of
the spine in order to perform the spinal surgery procedure. The
invasiveness of such techniques often results in excessive damage
to the normal anatomy, and significant and dangerous blood
loss.
In an attempt to minimize risks associated with spinal surgery
procedures, some surgical techniques have been developed wherein
only portions of the spinal column area are accessed during various
stages of the surgical procedure. In these procedures, a smaller
incision can be used to access a particular portion of the spinal
column area. However, access to only a particular portion of the
spinal column area does not provide sufficient access for all
surgical procedures.
In general, improvement has been sought with respect to such
surgical techniques, generally to better provide sufficient
accessibility to a spinal column area while minimizing anatomical
trauma and blood loss.
SUMMARY
One aspect of the present disclosure relates to a surgical
instrument for distracting a space between adjacent vertebral
elements and retracting the nerve root to provide access to the
distracted space. The instrument includes an elongated member
having a first end and a second end, the first end defining a
curved region. The instrument also includes a handle extending from
the elongated member and a wing extending outward from the
elongated member. The handle is positioned adjacent to the second
end of the elongated member and the wing is positioned adjacent to
the first end of the elongated member.
Another aspect of the present disclosure relates to a surgical
instrument having an elongated member having a longitudinal axis
that extends from a first end to a second end. The elongated member
has first and second edges that extend generally parallel to the
longitudinal axis. The instrument further includes a handle
positioned adjacent to the second end of the elongated member. A
wing extends outward from one of the first and second edges of the
elongated member and a recess is formed in the other of the first
and second edges of the elongated member.
Still another aspect of the present disclosure relates to a
distracting first and second adjacent vertebral elements. The
method includes providing a surgical instrument having an elongated
blade member, the elongated blade member having a longitudinal axis
extending between a first end and a second end, and a wing located
adjacent to the first end. The method further includes inserting
the surgical instrument in a first orientation between the first
and second vertebral elements and rotating the instrument to
distract the first and second vertebral elements a distance.
A variety of examples of desirable product features or methods are
set forth in part in the description that follows, and in part will
be apparent from the description, or may be learned by practicing
various aspects of the disclosure. The aspects of the disclosure
may relate to individual features as well as combinations of
features. It is to be understood that both the foregoing general
description and the following detailed description are explanatory
only, and are not restrictive of the claimed invention.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a perspective view of one embodiment of a surgical
instrument according to the principals of the present disclosure,
the embodiment having a left-handed configuration;
FIG. 2 is a first side elevational view of the surgical instrument
of FIG. 1;
FIG. 3 is a second side elevational view of the surgical
instrument, the embodiment having a right-handed configuration, and
shown without a handle;
FIG. 4 is a top plan view of the surgical instrument of FIG. 3;
FIG. 5 is a side elevational view of the surgical instrument,
having a left-handed configuration, shown in a first relation to
first and second vertebral elements;
FIG. 6 is a bottom plan view of the surgical instrument of FIG. 5,
shown in a second relation to the first and second vertebral
elements; and
FIG. 7 is a view of the surgical instrument of FIG. 6, shown from a
direction represented by line 7--7, and shown in the second
relation to the vertebral elements (only the second vertebral
element is illustrated).
DETAILED DESCRIPTION
Reference will now be made in detail to various features of the
present disclosure that are illustrated in the accompanying
drawings. Wherever possible, the same reference numbers will be
used throughout the drawings to refer to the same or like
parts.
FIGS. 1 7 illustrate a surgical instrument embodiment having
features that are examples of how inventive aspects in accordance
with the principals of the present disclosure may be practiced.
Referring to FIG. 1, the surgical instrument 10 includes an
elongated member 12 and a handle 14. A surgeon, for example, grasps
the handle 14 to manipulate the elongated member 12 during use.
That is, the handle 14 is used to apply an insertion force and can
be use to rotate the surgical instrument 10 to a desired
orientation in relation to the vertebral elements during a surgical
procedure. The handle 14 is also used to remove the elongated
member 12 of the surgical instrument from between the vertebral
elements.
Referring now to FIGS. 1 and 2, the elongated member 12 generally
defines a blade 16. The blade 16 has a first end 18 and a second
end 20 that defines a longitudinal axis A--A of the elongated
member 12. The blade has first and second edges 22, 24 extending
generally parallel to the longitudinal axis. In the illustrated
embodiment, the blade 16 has a concave curvature 26 relative to a
plane BB (represented by line BB) defined by the first and second
edges 22, 24. The concave curvature 26 is generally perpendicular
to the longitudinal axis A--A of the blade 16 and typically extends
along a majority of the blade 16. In the illustrated, the concave
curvature extends from the first end 18 of the blade to the second
end 20.
Still referring to FIGS. 1 and 2, a wing 28 is located adjacent to
the first end 18 of the blade 16 along one of the first and second
edges 22, 24 of the blade 16. In the illustrated embodiment of
FIGS. 1 and 2, the wing 28 is located along the first edge 22 for
use in a left-handed application. That is, the surgical instrument
10 having the wing 28 located on the first edge 22 is for use in an
application wherein the two vertebral elements are accessed from a
posterior approach, and from a patient-left side of the two
vertebral elements.
In the illustrated embodiment of FIGS. 3 and 4, the wing 28 is
located along the second edge 24 for use in a right-handed
application. That is, the surgical instrument 10 having the wing 28
located on the second edge 24 is for use in an application wherein
the two vertebral elements are accessed from a posterior approach,
and from a patient-right side of the two vertebral elements. During
a surgical procedure, either the right-handed instrument or the
left-handed instrument can be used when accessing the vertebral
elements from the respective patient-right or patient-left
side.
The wing 28 extends generally perpendicular to the plane BB defined
by the first and second edges 22, 24 of the blade 16. Referring to
FIG. 2, the wing 28 has a height H extending from a top edge 30 of
the wing 28 to the plane BB (FIG. 1); although the disclosed
principles can be applied in a variety of sizes and applications.
The height H of the wing is preferably between 5 and 15 mm; more
preferably between 8 and 12 mm.
In addition, the wing 28 is located a distance d from the first end
18 of the blade 16. The distance d extends from a rounded tip 36
(FIG. 1) at the first end 18 of the blade 16 to a front edge 60 of
the wing 28. The distance d of the wing is preferably between 12
and 30 mm; more preferably between 18 and 26 mm.
Still referring to FIGS. 1 and 2, the blade 16 has a generally
linear region 42 and a curved region 32. The curved region 32 is
located at the first end 18 of the blade 16. The curved region 32
curves away from the plane BB defined by the first and second edges
22, 24 of the blade 16. That is, the curved region 32 has a convex
curvature 34 that curves downward from the plane BB of the blade
16. The curved region 32 extends into the rounded tip 36 of the
blade 16.
The handle 14 is located adjacent the second end 20 of the blade
16. The handle 14 includes a handle shaft 38 (FIG. 3) having an
angled portion 40 and an extension portion 44. The angled portion
40 positions the extension portion 44 so that the surgical
instrument 10 is easily and ergonomically maneuverable. A handle
grip 46 is attached to the extension portion 44 of the handle shaft
38. The handle grip 46 can be attached by a fastener 48, such as a
pin or threaded member, or may be attached by a bonding agent or
weldment, for example.
Referring again to FIG. 1, a cutout section or recess 54 is located
adjacent to the first end 18 of the blade 16 along one of the first
and second edges 22, 24 of the blade 16. In particular, the recess
54 is located on the edge opposite the wing 28. In the left-handed
embodiment of FIG. 1, the recess 54 is formed along the second edge
24 of the blade 16. In the right-handed embodiment of FIG. 4, the
recess 54 is formed along the first edge 22 of the blade 16.
In the illustrated embodiment the recess 54 defines a curvature
having a radius of approximately 1.5 inches. As will be described
in greater detail hereinafter, the recess 54 provides clearance
during use to permit the surgical tool 10 to be rotated or oriented
from a first orientation relative to the vertebral elements to a
second orientation.
Referring to FIGS. 2 and 3, the second end 20 of the blade 16
includes an extension 50 that extends outward from the blade 16
along the longitudinal axis A--A. The extension 50 defines an
impact surface 52. The impact surface 52 can be defined only by the
extension 50 of the blade 16, or may include a shaped surface or
other structure designed to receive impact and positioned at the
second end 20 of the surgical instrument.
Referring now to FIGS. 5 7, in use, the surgical instrument 10 may
be used to distract two adjacent vertebral elements V1, V2. Prior
to use of the instrument 10, portions of the lamina 86 (FIG. 7) of
the first vertebral element V1 and the inferior facet 88 (FIG. 5)
of the second vertebral element V2 are typically removed to provide
access to the distraction site. (E.g., a lateral aspect of the
lamina of the first vertebral element V1 and a superior aspect of
the inferior facet of the second vertebral element V2 are typically
removed.) In this particular application shown, the instrument is a
left-handed instrument and the procedure is being performed on the
patient-left side of the two vertebral bodies.
To insert the instrument 10, the instrument is oriented such that
the handle 14 is directed toward the head of a patient when the
patient is lying on his front, as shown in FIG. 5. The instrument
10 is then inserted between the inferior endplate 82 of the first
vertebral element V1 and the superior endplate 84 of the second
vertebral element V2. The rounded tip 36 (FIG. 1) of the instrument
10 aids in insertion. The surgeon may also use a tap hammer (not
shown) on the impact surface 52 of the blade 16 to assist in
insertion of the instrument 10.
The distance d of the wing 28 from the first end 18 (FIG. 2) is
configured to limit the insertion depth of the instrument 10. That
is, the front edge 60 of the wing 28 functions as a stop. During
use, the front edge 60 contacts the posterior aspect 88 of the
first vertebral element V1 (FIG. 7) to indicate to the surgeon that
the proper insertion depth of the instrument 10 has been
reached.
To distract the first and second vertebral elements, the instrument
10 is rotated typically about 90 degrees in a direction C (FIG. 5)
about the longitudinal axis A--A of the blade 16. Referring back to
FIG. 1, the direction C is in the direction toward the wing 28.
Thus, the direction C of rotation of the right-handed embodiment
will be opposite the direction C of rotation of the left-handed
embodiment.
FIG. 6 illustrates the orientation of the instrument 10 of FIG. 5
in relation to the vertebral elements when rotated 90 degrees to a
distracted position. As the instrument 10 is rotated, the wing 28
sweeps around in an arc to retract the nerve root 80 (FIG. 7). The
wing 28 gently holds the nerve root 80 located at the inferior
aspect of the first vertebral element V1 in a stationary position.
As shown in FIG. 7, when positioned in the distracted orientation,
the wing 28 retracts or holds the nerve root out 80 of the way so
that the surgeon can easily access the distracted site.
The recess 54 formed on one of the first and second edges 22, 24 of
the blade 16 provides for clearance for the inferior aspect of a
superior pedical 90 (FIG. 5) of the first vertebral element V1.
That is, while the surgeon is rotating the instrument 10 from the
first position shown in FIG. 5 to the second position shown in
FIGS. 6 and 7, the recess 54 permits the blade 16 to rotate without
interference. This reduces the amount of bone removal necessary to
access the distraction site as required by conventional distraction
procedures.
The curved region 32 of the surgical instrument 10 assists in
protecting the dura (not shown) medially during and after insertion
of the instrument. In addition, the curved region 32 provides
stability when rotated to the second position or the distraction
position shown in FIGS. 6 and 7. That is, support edges or surfaces
56, 58 of the curved region 32 (FIG. 1) contact the superior and
inferior endplates of the vertebral elements in a non-linear
fashion. This arrangement distributes the contact points of the
support surface 56, 58 in a non-linear arrangement to increase the
support stability as compared to an instrument having a straight
edge or end.
As can be understood, the distance of distraction or the space
created between the first and second vertebral elements V1, V2 is
determined by a width W (FIG. 4) of the first end 18 of the blade
16. Referring back to FIG. 4, the width W of the first end 18
extends between the support surfaces 56, 58 of the blade 16. The
width W is preferably between 5 and 15 mm; more preferably between
6 and 12 mm. Typically, the surgeon chooses a blade 16 having a
particular width that corresponds to the size of the implant that
is to be inserted between the first and second vertebral
elements.
With the two vertebral elements V1, V2 distracted, and the nerve
root 80 retracted by the instrument 10, the surgeon can insert
tools to prepare the distracted site for insertion of a spinal
implant. For example, boring tools can inserted into the distracted
site to drill and ream the site for implantation. The concave
curvature 26 of the blade 16 guides the boring tool to the
distracted site. That is, the radius of the concave curvature 26
cradles diametrically configured tools to guide the tools axially
along the longitudinal axis A--A of the surgical instrument 10. The
concave curvature 26 can also be used to guide the implant and
implant insertion tools.
The curved region 32 of the first end 18 of the blade further
assists the surgeon during a surgical procedure by providing visual
access to the distracted site. The curve region 32 curves away from
the location where, for example, an implant bore is formed. The
surgeon can look down the longitudinal axis A--A of the instrument
10 and better view the formed implant bore, as the first end of the
instrument 10 at the distracted site curves away from the formed
implant bore and the longitudinal axis A--A of the instrument
10.
In an alternative method of use, the surgical tool 10 may simple be
inserted between the first and second vertebral elements in the
distracted position as shown in FIG. 6. That is, the surgical
instrument may be oriented as shown in FIG. 6, and inserted between
the elements as shown. The rounded tip 36 of the instrument 10 aids
in insertion as the first and second support surface 56, 58 contact
the superior and inferior endplates 82, 84. Similar to the previous
method, the surgeon may also use a tap hammer on the impact surface
52 of the blade 16 to assist in insertion.
The above specification provides a complete description of the
COMBINED DISTRACTOR AND RETRACTOR INSTRUMENT. Since many
embodiments of the invention can be made without departing from the
spirit and scope of the invention, certain aspects of the invention
reside in the claims hereinafter appended.
* * * * *